Fertility and sexuality in young cancer survivors who have adult-onset malignancies

Post-treatment fertility and sexuality are important issues to be considered before treatment starts in young adult patients who have cancer. Most male cancer survivors who have malignancies typical for young adulthood preserve the potential to father a child. Fertility remains decreased in comparable females treated for cancer in reproductive years. Postdiagnosis sexual life is affected, more so in females than in males, and was found to be strongly associated with emotional aspects of partnership. Communication about fertility and sexuality must become an integrated part of cancer survivors' follow-up.     

朗格汉斯组织细胞增生症2例并文献复习

目的：探讨朗格汉斯组织细胞增生症的临床病理特点、鉴别诊断及生物学特征。方法：对2例朗格汉斯组织细胞增生症进行组织学观察和免疫组化染色，并复习相关文献。结果：两例患者分别为成人和儿童，均以头部肿物为首发症状，伴有不同程度的颅骨破坏。手术切除病灶后成人无复发，儿童一个月后颈部又发现肿物并侵犯横纹肌。2例均经病理学诊断为朗格汉斯组织细胞增生症。结论：朗格汉斯组织细胞增生症是一种影响网状内皮系统的疾病，主要以朗格汉斯细胞浸润为主，组织学为良性，但其生物学行为却呈侵袭性、破坏性，可累及骨、肺等多个器官。     

Comment aborder la mort avec les enfants et les familles ?

Taking care of a child or an adolescent in palliative stage is a testing work for health professionals in paediatric onco-hematology. The communication with the child at the end of life and his family is delicate but however essential to ensure quality cares while supporting trust. The continuation of a genuine relation and a regular information concerning the child's health help the parents to progressively understand the lack of possible cure and the future death of their child. This anticipation also allows to possibly discuss about conditions and place of death of the ill child or adolescent. The child or adolescent himself at the end of life can also feel the need for speaking about his situation. It is then for the adult, parent or health professional, to share with him his questionings and his possible worries in order to reduce his loneliness and his fears. To let be guided by the child allows to respect his progression and his wish to know more about it or not. Finally a support must also be offered for the siblings.     

Unpasteurized milk consumption and subsequent risk of cancer

Concerns have been raised regarding the possible adverse health effects of consumption of unpasteurized milk and risk of cancer. We examined the association of self-reported intake of unpasteurized milk with subsequent risk of cancer in a large population-based cohort study. The Iowa Women’s Health Study is a prospective cohort study of 55–69 year old women at baseline in 1986. Of the 41,836 women in the cohort at baseline, 22,808 cancer-free women completed the fourth follow-up questionnaire in 1997. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression analysis. Reported intake of unpasteurized milk was high: 59.2% consumed only as a child, 2.5% consumed only as an adult, and 16.5% consumed as a child and an adult. A total of 2,379 cancers were identified in the cohort at risk. Overall, the age-adjusted risk of cancer was lower among women who reported consumption of unpasteurized milk only as a child (RR = 0.90, 95% CI: 0.82–0.99) or as a child and an adult (RR = 0.85; 95% CI: 0.75–0.97). Adjustment for confounding factors attenuated these associations (RR = 0.92, 95% CI: 0.83–1.02 for consumption only as a child, and RR = 0.91; 95% CI: 0.79–1.04 for consumption as a child and an adult). These data suggest that consumption of unpasteurized milk does not increase risk of cancer.     

Les théories de la sexualité dans le champ du cancer : les savoirs infirmiers

This article discusses the various lines of research currently pursued on the representations of sexuality among oncology nurses. To test our hypotheses, we based our conclusions on observations made during a scientific meeting that took place in July 2006 in Rotterdam and the analysis of the specialized international literature (Medline). During the meeting of the International Society for Sexuality and Cancer (ISSC), we confronted some of our theoretical intuitions and also studied the theories of sexuality that are currently used in oncology. Our analysis of the literature revealed that the different ways of speaking about sexuality were subject to a division of labour within the cancer care team. On the one hand, when addressing cancer-or treatment-related sexual dysfunction, specialists, such as oncologists, gynaecologists and urologists take the responsibility. On the other hand, when providing information about sexuality, including self-esteem, self-knowledge and other areas, nurses play the central role. This division is so stark that one physician questioned believed it absolutely possible to resolve sexual dysfunction without considering questions of “sexuality”.     

Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis

We examined degree and determinants of change in body image and sexuality over the first year following breast cancer diagnosis to differentiate body image and sexuality trajectories, and then explored if differences in trajectories predicted 6 years’ psychosocial outcomes. 363/405 (90%) Chinese women receiving surgery for BC were assessed at 5-days (Baseline), 1-month, 4-months, and 8-months post-surgery. Psychological distress, treatment decision making (TDM) difficulties, satisfaction with treatment outcome, optimism, and self-efficacy were assessed at Baseline. Self-image and sexuality were recorded at each follow-up assessment. Latent growth mixture modeling identified trajectories of self-image and sexuality. Multinominal logistic regression identified factors predicting trajectory patterns. Six years later 211/363 (58%) of the original patients were successfully traced and their psychosocial status assessed. Three distinct trajectories of self-image and sexuality were identified: high-stable, recovery, and high-deteriorating. Most women (64% self-image; 58% sexuality) showed stable levels of self-image and sexuality scores. TDM difficulties, satisfaction with treatment outcomes, physical symptom and psychological distress predicted trajectory patterns. Self-image trajectories over the first year diagnosis predicted 6-years psychosocial outcomes. Women with high-stable level of self-image had the best 6-year self-image and sexuality; women with initial low level of self-image had significantly greater long-term psychological distress. Low TDM difficulties and high treatment outcome satisfaction predicted high and stable self-image and sexuality. Type of surgery showed little impacts on self-image and sexuality. Self-image during acute illness phase predicted long-term outcomes. Interventions should focus on minimizing self-image decrement.     

Perceptions d’enfants et d’adultes sur le bien-être après une tumeur cérébrale pédiatrique

The aim of this study was to determine how child and adult survivors of paediatric brain tumours perceive their well-being. Content analysis of interviews with 49 participants revealed their criteria of well-being, what contributes to it, the way they behave to feel well, and some perceived benefits from the cancer experience. Cognitive maturity and challenges in the life cycle may explain the differences in perceptions observed between children and adults. These should be taken into account in interventions to promote the long-term well-being of these patients.     

La sexualité du couple face au cancer : regards de femmes

Introduction

In Western society, a couple’s sexuality is increasingly becoming an indicator of its survival. What is the effect then when something as disruptive as cancer affects a person’s sexual and family life? How does this affect a relationship which up to that point has been an intimate one? In an attempt to explore how treatments effect family relationships, two situations were investigated side-by-side; the first was women being treated for a gynaecological cancer and the second related to women whose partner was being treated for prostate cancer. This allowed answers to these questions to be provided by exploring the perspectives of women towards their sexuality and their relationships in light of disease.

Methodology

Open or semi-guided individual interviews carried out in accordance with anthropological methods.

Population

30 women with uterine cancer, being treated with high-dose radium therapy on an outpatient basis and monitored for two years, and 10 partners of men being treated for prostate cancer with external radiotherapy. Average age 58 years.

Results

— For women with cancer, treatment and the disease are the primary focus (treatment type, radioactivity, fear of relapse). They only think about their sexuality when they are «free» of all treaments and when they are in the follow-up stage — For partners of male patients, sexuality and wellbeing of the partner are the two primary «areas» raised during interviews. The relationship to the other differs: for patients, one must «confront» and try to explain to partners the physical consequences, whereas wives of patients adopt a recurrent theme surrounding their sexual life based on an «I understand» approach... When the body is in pain, the effect of how the body is viewed is felt immediately, whereas when it is the body of a spouse that is in pain, how the body is viewed has less significance than how one acts towards the other. The sick body, that one can touch, that one is allowed to touch, and how it is viewed is shown to be a factor of a new type of sexuality.

Conclusion

The primary effect when cancer affects the sexual organs is the effect on sexuality and therefore the stability of the couple. This is variously accepted depending on whether one is the patient or not; and whether one is male or female. This «differential valency of the sexes», as Françoise Héritier calls it, finds its context in a socio-cultural approach to sexuality: society impressing on the individual how sexuality and married life should be viewed, which is revealed here through the female perspective. Similar research should certainly be conducted in men in order to counterbalance this research and to evaluate the male perspective in similar situations. Research conducted with finance provided by the Cancer League.     

全中枢神经系统放射治疗新技术探讨

目的:探讨全中枢神经系统放射治疗更加合理、实用的新技术。方法:应用放疗计划系统针对成人和儿童患者分别制定四种不同照射方法的放疗计划,并比较各放疗计划的剂量分布指标。结果:经对比观察分析,几种计划方法在成人和儿童患者各有优缺点。结论:根据患者个体情况采用CT模拟定位、放疗计划系统、三维适形调强放疗技术为基础的多种全中枢系统照射技术方法,结合计划验证和图像引导技术指导治疗计划实施,都具有一定的实用性和较强的准确性、安全性。     

L’évolution des liens entre cancer et sexualité : revue critique de la littérature

This critical literature review aims to analyze the links between cancer and sexuality since the mid- 20th century until today. Three bibliographic corpora have been mobilized: a “medical” corpus, a “psychological” corpus, and a corpus made of gray literature on this topic. The history of the link between cancer and sexuality is characterized by a notion of reversing the causal links between these two objects. From interpreting sexuality mainly as a cause of the onset of cancer, we have now moved to a model of the alteration of sexuality linked to cancer and its treatments. This evolution is marked by the recent introduction of a new discipline dedicated to cancer and sexuality in the current context of sexual health.     

Reimagining care for adolescent and young adult cancer programs: Moving with the times

Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer. Cancer 2016;122:1038–1046. © 2016 American Cancer Society     

Cancer du sein et sexualité chez des couples tunisiens confrontés au poids de l’incertitude vitale

The influence of breast cancer treatment on sexuality remains very poorly explored in Tunisia. In this study, we looked at the sexuality issues in two Tunisian women with breast cancer.We classified these sexual issues into five categories: communication troubles with the attending physician, distortion in beliefs about cancer, sexuality or treatment, depressive reaction to the disease or treatment, modification of the body shape, and communication troubles within the couple. Sexually attractiveness is an important quality for Tunisian women with breast cancer.     

Discussing sexuality in the clinical setting: The impact of a brief training program for oncology health professionals to enhance communication about sexuality

Aim: Cancer and its treatments can profoundly affect a person's sexuality and self‐image. However, oncology health professionals (OHP) are often reluctant to discuss these issues with patients. Cancer Council Victoria developed a short workshop to increase OHP's discussion of sexuality issues with cancer patients. We examined the immediate and longer term effect of workshop participation on perceived barriers to these discussions, their confidence in initiating the discussions, and changes in the frequency of their discussing sexuality issues with patients. Method: Twenty‐one workshops were conducted involving 155 OHP. The workshops were run by trained facilitators and incorporated cognitive, behavioral and experiential components. A major part of the workshop involved role‐playing with simulated patients (trained actors). Questionnaires assessing 20 perceived barriers, seven confidence items and seven practices concerning sexuality discussion were completed by the participants pre‐workshop, immediately post‐workshop, and 8‐weeks post‐workshop. Results: Overall 89 participants completed all three assessment phases. Data were analysed to assess change in perceived barriers, confidence and behavior across the three assessment points. Mean scores on 16 of the 20 barriers significantly decreased and scores on all seven confidence measures significantly increased between pre‐ and immediate post‐workshop. Most these changes were maintained 8 weeks later. The mean frequency of sexuality issue discussion in the previous 2 months increased significantly from 3.34 times at pre‐workshop to 3.82 times 8 weeks later (P = 0.003). Conclusion: This workshop appeared to reduce perceived barriers, increase confidence and increase actual practices around discussing sexuality issues with cancer patients.     

1例成人神经母细胞瘤的临床诊治分析

神经母细胞瘤是儿童期常见恶性实体瘤，其临床表现及转归异质性很强，临床诊断复杂，需结合影像检查结果、病理细胞形态及免疫组化、基因及分子生物、手术切除范围等几个方面综合评价，根据临床分期并考虑不良预后因素的数量等指标按危险程度分级诊断，并据此制定相应综合治疗方案。成人病例临床罕见，尚缺乏相关诊治规范，诊断及治疗可参照儿童神经母细胞瘤诊治标准实施，现介绍1例成人病例，确诊为神经母细胞瘤4期，全身化疗后病情明显缓解，具有进一步外科手术指征，可作为多学科协作综合治疗有效的经验，对其他类似患者的诊治提供思路和方向。      

Discussing sexuality in the clinical setting: The impact of a brief training program for oncology health professionals to enhance communication about sexuality

Aim:   Cancer and its treatments can profoundly affect a person's sexuality and self-image. However, oncology health professionals (OHP) are often reluctant to discuss these issues with patients. Cancer Council Victoria developed a short workshop to increase OHP's discussion of sexuality issues with cancer patients. We examined the immediate and longer term effect of workshop participation on perceived barriers to these discussions, their confidence in initiating the discussions, and changes in the frequency of their discussing sexuality issues with patients.
Method:   Twenty-one workshops were conducted involving 155 OHP. The workshops were run by trained facilitators and incorporated cognitive, behavioral and experiential components. A major part of the workshop involved role-playing with simulated patients (trained actors). Questionnaires assessing 20 perceived barriers, seven confidence items and seven practices concerning sexuality discussion were completed by the participants pre-workshop, immediately post-workshop, and 8-weeks post-workshop.
Results:   Overall 89 participants completed all three assessment phases. Data were analysed to assess change in perceived barriers, confidence and behavior across the three assessment points. Mean scores on 16 of the 20 barriers significantly decreased and scores on all seven confidence measures significantly increased between pre- and immediate post-workshop. Most these changes were maintained 8 weeks later. The mean frequency of sexuality issue discussion in the previous 2 months increased significantly from 3.34 times at pre-workshop to 3.82 times 8 weeks later ( P  = 0.003).
Conclusion:   This workshop appeared to reduce perceived barriers, increase confidence and increase actual practices around discussing sexuality issues with cancer patients.     

Y a-t-il des spécificités psychologiques dans le vécu et la prise en charge des patients atteints de cancer colorectal ? Une expérience alsacienne

The Alsace was a pilot department for the screening of colorectal cancer because of the incidence of this cancer in this region. This article deals with the experience of a pluri-disciplinary team from Colmar on CCR. Some psychological aspects of colorectal cancer have the usual features associated with cancer: traumatic communication of diagnosis, fear of death, surgery, chemotherapy. But in addition, this cancer endangers the privacy of the excreting process, a highly symbolic function in child development with respect to affirmation of the separate ego. Harm to the colon, rectum or anus restores infantile defence mechanisms because regression is needed in order to allow another to provide treatment, but this regression is quickly suppressed by patients who want to deal with their stoma and the healing process independently. The treatment consequences of such cancers on sexuality are particularly significant in that the partner is often involved, sometimes physically, but more often in supporting the patient in regression by playing a maternal role or by supporting the patient with love and affection.     

Sexualité féminine et cancer : une recherche exploratoire

The cancerous disease and its treatments are able to perturb in a important way the sexual life of the patients and their quality of life. We realized a research which aimed, on one hand, at estimating the acceptance of a questionnaire about sexuality on female patients and, on the other hand, at studying the potential links between sexual function, quality of life, body image, psychic suffering and relation with the partner. On 106 sought female patients, 69 (65.1%) agreed at first instance to participate in the study. However, only 33 (31.1% of the global sample) answered effectively the questionnaire. The non-participants distinguish themselves mainly by their higher age, the fact that they are more frequently menopausal and inactivate on a professional level. The reasons most frequently evoked to refuse to fill the questionnaire differ as the patients refuse it spontaneously (absence of sexual partner) or after reading (too intimate). A matrix of correlation puts in evidence the links between dimensions of the sexuality, age, body image, relation maintained with the sexual partner and the quality of life. The results bring to light the interest to question the link between sexuality and biopsychosocial experience of the disease. However, the questioning of “the intimate” within the cancer care seems to collide with the limits that the patients can pose.     

Dose de tolérance à l’irradiation des tissus sain : les testicules

Although there is very little evidence for direct irradiation of the testes, they may receive significant doses, especially in the treatment of pelvic tumors in adults and in pediatrics. The exocrine function of the testis seems to be more sensitive to radiotherapy. There is a risk of sterility, even after low doses of radiation. In the adult or the child who has reached puberty, we should propose a self-preservation of semen prior to radiotherapy. In pre-pubescent children, the problem is more delicate. In all cases, it is necessary to limit the dose to the testicles without affecting the coverage of tumour volume. Patients and/or their caregivers should be systematically informed of the risk of infertility related to irradiation.     

Vécu psychologique de la sexualité chez les hommes ayant un cancer de la prostate primitif et localisé

Taboos related to cancer, ageing and sexuality are still topical and challenge sexuality for prostate cancer patients. Analysis of interviews with patients highlights the changes caused by the disease and treatments and the significance that they have on sexual life. Doctors must therefore focus on quality of life for these men whose masculinity is deeply affected.